HomeMy WebLinkAboutIslands End Golf 2
• td1 Town Hall, 53095 Main Road
V. `0•/ P.O. Box 1179
='r�®1 ,�' Southold, New York 11971
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JUDITH T.TERRY ------,,,,,,,,00 FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 112-N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
New Existing X
Name Of Owner ISLAND END GOLF AND COUNTRY
Mailing Address 1 CLUB, INC.
Mailing Address 2 P. O. BOX 2066
City St Zip GREENPORT NY 11944-0000
Property Address 1 ROUTE 25
Property Address 2
City St Zip GREENPORT NY 11944-0000
Owner Telephone No. 516-477-9457
Tax Map No. section 35.00 block 2 lot 17.001
Cross Street MAPLE LANE
Date Of Last Pump Out 0/00/00
Issue Date: 9/25/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OFFICE OF THE TOWN CLERK ' I,cJ�F'Fe
Town o'1'Southold � C� Application Noe( , //
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road =E $10.00 - Residential
P. O. Box 1179 cr3 =`TY> i �` $25.00 - Non-Residential
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Southold, New York 11971 '® �J
Telephone
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. -
Fee $ •
DATE CV/lb O -
'OWNER NAME:
u ; •
OWNER MAILING ADDRESS: P.J. Rex 2066
- --
11944
OWNER PROPERTY ADDRESS: C � l /1/ k,& CAST OF if��-
ep(=c�N �- !�`P.
OWNER TELEPHONE NUMBER: /G - y77 „ 7 LIS'?
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TAX MAP NO. : Section � Block Lot /0'4(RC'S'
CROSS STREET: M Pk F A,r c- C('RIvi9-T(.-
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool DC-- New Existing X
Residential Non-Residential
DATE OF PREVIOUS PUMP-OUT: J cJ ve — (9 /0
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
4
/ Signature of 1,1p scant
RECEIVED BY:
Town Clerk's Office
DATE:
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